Acute Myeloid Leukemia AML : Causes,Clinical Features

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ACUTE MYELOID LEUKEMIA

Related topics

Classification,Diagnosis and Prognostic Factors

Treatment and Future Hold For AML

Dr Ira Shah
M.D, DCH(Gold Medalist), FCPS, DNB
Edited by Dr. Bharat R Agarwal
Consultant Pediatric Hematologist and Oncologist.

Q. What is acute myeloid leukemia?

A. Cancer of the non-lymphoid series of the blood is called myeloid leukemia. It is also called acute myelogenous leukemia or AML, acute nonlymphocytic leukemia or ANLL. It accounts for almost 15- 20% of all childhood leukemia. The ratio of ALL: AML is 4:1.

Q. How does it occur?

A. Though the etiology is still unknown, it is associated with various environmental and genetic factors. It has been seen increasingly in patients with:

Genetic disorders :
- Down's syndrome
- Bloom's syndrome
- Fanconi's anemia etc.
However, majority of children with Down's syndrome and AML can be cured of their leukemia. Neonates with Down's syndrome may manifest a transient myeloproliferative syndrome which mimics congenital AML but improves spontaneously with 4-6 weeks.
Environmental factors :
- Exposure to ionizing radiation.
- Chemical exposure to benzene & hydrocarbons.
- Treatment with alkylating agents.

Patients with acquired diseases such as myelodysplastic syndromes, myeloproliferative disorders and other pre-leukemic states are at an increased risk.

Q. What are the clinical features?

A. These children present either with very few symptoms or with severe sepsis, bleeding etc, which indicate marrow failure and involvement of extramedullary organs. Certain features are unique to a particular sub-type of AML for e.g.

Patients with acute promyelocytic (M3) leukemia may have intravascular coagulopathy due to clotting factor deficiency resulting in severe bleeding.
Patients with M4 & M5 AML(monocytic component) may have associated gingival hypertrophy from leukemic infiltration, They may also develop meningeal leukemia, retinal infiltration, leukemia cutis or other localized leukemia infiltrations. They may also have chloromas, which are granulocytic sarcomas seen commonly in the skin and have a dull green color due to the high peroxidase content in the leukemia cell.

In addition, in patients with AML, 1/3 of patients may spleenomegaly. Hyper-uricemia is also very common.

Next : Classification,Diagnosis and Prognostic Factors

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